Journal
EUROPEAN UROLOGY
Volume 60, Issue 1, Pages 125-130Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.eururo.2011.01.015
Keywords
C11 choline PET-CT; Diffusion weighted MRI; Lymph node staging; Prostate cancer; High risk; Imaging
Categories
Funding
- IWT, the government agency for Innovation by Science and Technology in Flanders, Brussels [IWT TBM 060793]
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Background: Contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging for lymph node (LN) staging of prostate cancer (PCa) are largely inadequate. Objective: Our aim was to assess prospectively the sensitivity, specificity, and positive and negative predictive values for the LN staging by C-11-choline positron emission tomography (PET)-CT and MR diffusion-weighted imaging (DWI) of the pelvis before retropubic radical prostatectomy (RRP) with extended pelvic LN dissection (PLND). Design, setting, and participants: From February 2008 to August 2009, 36 patients with histologically proven PCa and no pelvic LN involvement on contrast-enhanced CT with a risk >= 10% but <= 35% at LN metastasis according to the Partin tables were enrolled in this study. Intervention: Patients preoperatively underwent C-11-choline PET-CT and DWI. Subsequently all patients underwent a wide RRP and an extended PLND. Measurements: Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for LN status of 11C-choline PET-CT and DWI were calculated with the final histopathology of the LNs as comparator. Results and limitations: Seventeen patients (47%) had a pN1 stage, and 38 positive LNs were identified. On a LN region-based analysis, sensitivity, specificity, PPV, NPV, and the number of correctly recognised cases at 11C-choline PET-CT were 9.4%, 99.7%, 75.0%, 91.0%, and 7.9%, respectively, and at DWI these numbers were 18.8%, 97.6%, 46.2%, 91.7%, and 15.8%, respectively. Twelve LN regions containing macrometastases, of which 2 had capsular penetration, were not detected by C-11-choline PET-CT; 11 LNs, of which 2 had capsular penetration, were not detected by DWI. This is a small study with 36 patients, but we intend to recruit more patients. Conclusions: From this prospective histopathology-based evaluation of C-11-choline PET-CT and DWI for LN staging in high-risk PCa patients, it is concluded that these techniques cannot be recommended at present to detect occult LN metastases before initial treatment. (C) 2011 European Association of Urology. Published by Elsevier B. V. All rights reserved.
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